Can IPL be used to treat dry eyes after myopia surgery?
Abstract: This paper reports a group of retrospective cases, including the visual and clinical effects of intense pulsed light (IPL) after refractive surgery in patients with chronic lipid abnormality dry eye (DES).
In this paper, a total of 4 courses of treatment were conducted, and the Eye Surface Symptom Rating Questionnaire (OSDI) was completed before and after the last course of treatment. Data before and after treatment included visual acuity (VA), diopter, clinical evaluation (grading of dry eye symptoms, corneal fluorescence staining), corneal topography and other indicators. Twenty eyes were treated with IPL and the following data were recorded: Schirmer I: 14.7 ± 5.6; 15.6 ± 3.4 mm, tear rupture time (TBUT) 3.4 ± 1.6; 5.1 ± 1.2 s (p>0.003), tear content 3.4 ± 0.5; 1.6 ± 0.7 (p<0.003), corneal staining grade 0.8 ± 0.77; 0.4±0.75（p>0.003），VA 0.67±0.26； 0.90 ± 0.15 (p<0.0001), 0.90 ± 0.15 (p<0.0001), the best correction VA 0.83 ± 0.18; 0.92 ± 0.14 (p>. 003), corneal topography index -0.31 ± 0.6; −0.08±0.38 D（p>0.003），OSDI 34±16； 28 ± 11.0 points (p>0.003), the use frequency of artificial tears was 3.4 ± 2.0; 2.5 ± 1.9 times/day (p>0.03). After intense pulsed light IPL treatment, the clinical and visual acuity of patients with chronic evaporative dry eye were significantly improved, and the use frequency of artificial tears was reduced.
Dry eye syndrome (EDS) often occurs after LASIK refractive surgery and lasts for more than 6 months, with the incidence ranging from 0.8% to 44%. This was significantly correlated with preoperative dry eye symptoms and signs, preoperative high myopia, depth of ablation, female gender and other factors. Refractive patients may have dry eyes or EDS related clinical symptoms after surgery. Persistent visual impairment is one of the reasons for dissatisfaction of many follow-up patients. In addition, among EDS patients, the incidence of refractive error after LASIK is higher.
This study reviewed the treatment records of 34 patients with IPL, including 11 cases (20 eyes), 4 eyes underwent biomicroscopy after multifocal intraocular lens implantation, and 16 eyes underwent primary LASIK. The average age before IPL was 43.25 ± 15.6 years, and the average LASIK operation time was 28.3 ± 30.9 months (6-107 months). The degree of dry eye symptoms before and after IPL was 3.4 ± 0.5 and 1.6 ± 0.7 respectively (p ≤ 0.003). On the basis of the OSDI survey, 1 case of mild EDS, 6 cases of moderate EDS and 4 cases of severe EDS were recorded, with the range of 21 to 58 points. The results are shown in the following table:
(A) In daily activities, the average score of OSDI questionnaire before and after IPL was reduced in 67% of the patients, while the other 33% did not get worse (p>0.003), and the score of visual impairment was reduced (p>0.003);
(B) The activity behavior and discomfort symptoms were improved, and the frequency and discomfort of using artificial tears every day were reduced (1-7 times/day; p>0.003)
To sum up, IPL is a new method for the treatment of lipid abnormal dry eyes. This treatment technology can improve the tear film rupture time by heating the meibomian gland. For patients with meibomian gland dysfunction, IPL can reduce 81% of dry eye symptoms and improve tear film quality. The higher order aberration progression index was negatively correlated with BUT and OSDI. Therefore, if IPL can improve tear quality, it can be converted into improvement of visual quality VA.
In addition, IPL can also improve the ocular surface symptoms of myopic surgery patients, and reduce the use of artificial tears. Of all patients who received LASIK, 55% had improved symptoms.